Adverse childhood experiences in children of parents who are refugees affected by trauma
Authors: Leonie K Elsenburg, David Taylor-Robinson
Journal: The Lancet Public Health (2022)

What is the risk of adverse childhood experiences (ACEs) for a child who grows up in Denmark with a parent who is a refugee affected by trauma? In The Lancet Public Health, Line Bager and colleagues1Bager L Laursen TM Palic S Nordin L Høgh Thøgersen M Adverse childhood experiences among children of parents who are refugees affected by trauma in Denmark: a register-based cohort study.Lancet Public Health. 2022; (published online Sept 14.)https://doi.org/10.1016/S2468-2667(22)00194-3Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar used Danish registry data to address this question. As one might expect, the authors showed that these children are at higher risk of experiencing adversity compared with the rest of the population. More strikingly, the authors also showed that children of parents who migrate to Denmark from a refugee-sending country have a markedly higher risk of experiencing adversity. Estimates from several high-income countries, including Denmark, show that about half of all children experience childhood adversity,2Hughes K Bellis MA Hardcastle KA et al.The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis.Lancet Public Health. 2017; 2: e356-e366Summary Full Text Full Text PDF PubMed Scopus (2183) Google Scholar, 3Bengtsson J Dich N Rieckmann A Hulvej Rod N Cohort profile: the DANish LIFE course (DANLIFE) cohort, a prospective register-based cohort of all children born in Denmark since 1980.BMJ Open. 2019; 9e027217Crossref PubMed Scopus (23) Google Scholar and the experience of childhood adversity is more common for children growing up in disadvantaged socioeconomic circumstances.4Walsh D McCartney G Smith M Armour G Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review.J Epidemiol Community Health. 2019; 73: 1087-1093Crossref PubMed Scopus (178) Google Scholar Adversities such as childhood maltreatment, parental separation, and household mental illness frequently co-occur and are related to many adverse health and social outcomes in later life.2Hughes K Bellis MA Hardcastle KA et al.The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis.Lancet Public Health. 2017; 2: e356-e366Summary Full Text Full Text PDF PubMed Scopus (2183) Google Scholar, 5Metzler M Merrick MT Klevens J Ports KA Ford DC Adverse childhood experiences and life opportunities: Shifting the narrative.Child Youth Serv Rev. 2017; 72: 141-149Crossref Scopus (366) Google Scholar Our studies of the Danish population show that trajectories of childhood adversity are associated with an increased risk of mortality in early adulthood,6Rod NH Bengtsson J Budtz-Jørgensen E et al.Trajectories of childhood adversity and mortality in early adulthood: a population-based cohort study.Lancet. 2020; 396: 489-497Summary Full Text Full Text PDF PubMed Scopus (83) Google Scholar and that they explain up to half of the association between parental education level and mortality in early adulthood.7Elsenburg LK Rieckmann A Nguyen TL et al.Mediation of the parental education gradient in early adult mortality by childhood adversity: a population-based cohort study of more than 1 million children.Lancet Public Health. 2022; 7: e146-e155Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar The study by Bager and colleagues1Bager L Laursen TM Palic S Nordin L Høgh Thøgersen M Adverse childhood experiences among children of parents who are refugees affected by trauma in Denmark: a register-based cohort study.Lancet Public Health. 2022; (published online Sept 14.)https://doi.org/10.1016/S2468-2667(22)00194-3Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar built on the extensive literature in this area by examining the experience of adversity in children of parents who are migrants to a high-income country, and in a smaller subgroup of children of parents who are refugees affected by trauma who received treatment at specialised clinics. Bager and colleagues followed up a population of more than 2·5 million children who were either born in Denmark or who migrated to the country before their second birthday, and lived in Denmark between 1990 and 2016, to their 15th birthday. Children of parents who are migrants from refugee-sending countries and children of parents who are refugees affected by trauma were compared with all other children in Denmark. Bager and colleagues' findings showed that children with parents who are refugees affected by trauma had a higher risk of experiencing parental serious mental illness, parental substance use disorder, parental disability pension, not sharing the same address with both parents in early childhood, and parental somatic illness compared with the rest of the population.1Bager L Laursen TM Palic S Nordin L Høgh Thøgersen M Adverse childhood experiences among children of parents who are refugees affected by trauma in Denmark: a register-based cohort study.Lancet Public Health. 2022; (published online Sept 14.)https://doi.org/10.1016/S2468-2667(22)00194-3Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar This increased risk was independent of country or region of origin of the parents. Additionally, children of parents who are refugees affected by trauma were shown to be at higher risk for accumulation of ACEs than the rest of the population.1Bager L Laursen TM Palic S Nordin L Høgh Thøgersen M Adverse childhood experiences among children of parents who are refugees affected by trauma in Denmark: a register-based cohort study.Lancet Public Health. 2022; (published online Sept 14.)https://doi.org/10.1016/S2468-2667(22)00194-3Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar Bager and colleagues' findings further showed that the much larger group of children of parents who migrated from a refugee-sending country—about 10% of the study population—had a markedly higher risk of adversity than the general population, particularly for poverty, not sharing the same address with both parents in early childhood, parental disability pension, and parental somatic illness and serious mental illness. Bager and colleagues' study findings highlight interconnected issues related to migrant health, the intergenerational transmission of trauma, and socioeconomic conditions for children of parents who have migrated from a refugee-sending country, with implications for policy. Premigration experiences, such as exposure to torture, and traumatic experiences during migration, clearly have the potential for intergenerational impacts.8Sangalang CC Vang C Intergenerational trauma in refugee families: a systematic review.J Immigr Minor Health. 2017; 19: 745-754Crossref PubMed Scopus (116) Google Scholar Early identification, referral, and treatment at specialised clinics are likely to be appropriate forms of intervention in affected individuals and families. The children with parents who migrated from a refugee-sending country additionally represent a target group for public policy. The parents of these children might also have experienced high levels of trauma. Additionally, the postmigration context might contribute to the experience of adversity in children of parents migrating from refugee-sending countries. Policies introduced in Denmark in 2002 have led to lower income levels and increasing levels of poverty in migrants who are refugees,9Andersen LH Landersø R Dustmann C Lowering welfare benefits: intended and unintended consequences for migrants and their families.https://www.rockwoolfonden.dk/publikationer/lowering-welfare-benefits-intended-and-unintended-consequences-for-migrants-and-their-families/Date: 2019Date accessed: August 19, 2022Google Scholar and there is a growing literature on the adverse health consequences of non-health-targeted policies for migrants in high-income countries.10Juárez SP Honkaniemi H Dunlavy AC et al.Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis.Lancet Glob Health. 2019; 7: e420-e435Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar Although the use of register data is the great strength of Bager and colleagues' study because it allowed the authors to obtain objective information on the occurrence of ten different ACEs over the course of childhood, the registers do not include information on other important ACEs, such as discrimination or bullying.11Cronholm PF Forke CM Wade R et al.Adverse childhood experiences: expanding the concept of adversity.Am J Prev Med. 2015; 49: 354-361Summary Full Text Full Text PDF PubMed Scopus (526) Google Scholar Another limitation is that selection mechanisms might have resulted in only some parents who are refugees affected by trauma receiving treatment at the specialised clinics, such as those with more severe symptoms, or those with higher health-seeking behaviour. As such, not all children of this parent group might be identified, and some might be misclassified in this study. In summary, the study by Bager and colleagues shows that children of parents who are refugees and affected by trauma are at increased risk for several ACEs, as well as experiencing accumulation of ACEs. Worryingly, the study also shows that children of parents who migrated from a refugee-sending country are at increased risk for adversity; however, this group might be amenable to policy intervention. We declare no competing interests. Adverse childhood experiences among children of parents who are refugees affected by trauma in Denmark: a register-based cohort studyOur findings suggest that children with parents from refugee-sending countries have a higher rate of several ACEs compared with the general population. Furthermore, having a parent who is a refugee affected by trauma and seeking treatment seems to be an independent risk factor for poorer health and adjustment in adulthood. This study informs decision makers and caregivers that there might be much added value in addressing needs within the whole family, as opposed to only attending to the parent who is seeking treatment. Full-Text PDF Open Access